OVERVIEW OF PACT. Introduction to A Psychobiological Approach to Couple Therapy AGENDA 4/14/2014. Introduction to PACT
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1 Stan Tatkin, PsyD all rights reserved 1 Introduction to A Psychobiological Approach to Couple Therapy Stan Tatkin, Psy.D Stan Tatkin, Psy.D. Assistant Clinical Professor Department of Family Medicine University of California at Los Angeles David Geffen School of Medicine Stan Tatkin, PsyD all rights reserved 2 AGENDA Overview of the three domains Developmental neuroscience Arousal regulation Attachment theory Basic PACT interviewing process Stan Tatkin, PsyD all rights reserved 3 OVERVIEW OF PACT Stan Tatkin, PsyD all rights reserved 1
2 Stan Tatkin, PsyD all rights reserved 4 Attachment Trance Body Social Justice PACT Psychoanalytic Psychodrama / Gestalt Family Systems Neuroscience A Psychobiological Approach to Couple Therapy 5 PACT Therapists Offer a Unique Mix of Techniques We pay close attention to micro-movements and microexpressions. We pay special attention to all shifts and changes in arousal and affect. We work by using tensing and relaxing within a disjointed interview process focused on regulation. We prefer to stage or create experiences before making interpretations. We evoke problematic mental and emotional states in session and work with them in real time. We make bold statements to get partners to adjust and correct information according to their reality. We speak in plain language in a fearless and open manner to model safety and confidence in the therapeutic relationship Stan Tatkin, PsyD all rights reserved 6 THE THREE DOMAINS Attachment Theory Arousal Regulation Developmental Neuroscience Stan Tatkin, PsyD all rights reserved 2
3 Stan Tatkin, PsyD all rights reserved Stan Tatkin, PsyD all rights reserved 8 DEVELOPMENTAL NEUROSCIENCE Stan Tatkin, PsyD all rights reserved 9 A Deficit Model of Therapy Conflict model What issues disrupt the relationship Focus on psychological conflicts Top-down processing Deficit model What couples can and cannot do Focus on defenses and neurobiological deficits Bottom-up processing Stan Tatkin, PsyD all rights reserved 3
4 A Psychobiological Approach to Couple Therapy 10 MacLean s Triune Brain A Psychobiological Approach to Couple Therapy 11 Primitives and Ambassadors A Psychobiological Approach to Couple Therapy 12 Top-down Cognitive Explicit Declarative Left brain Slow Somatosensory Implicit Procedural Right brain Fast Bottom-up Stan Tatkin, PsyD all rights reserved Stan Tatkin, PsyD all rights reserved 4
5 Stan Tatkin, PsyD all rights reserved 13 The Sympathetic Nervous System: The Accelerator The Parasympathetic Nervous System: The Brakes Readies muscles for action Increases heart rate and blood pressure Constricts peripheral blood circulation, making skin pale or cold Shifts blood from digestive system to muscles Speeds up breathing Dilates pupils Reduces muscle tension, aids relaxation Lowers heart rate and blood pressure Returns blood to peripheral vessels, thus making skin warm and flushed Assists digestion Slows and deepens breathing Allows immune system to function Secretes bodily fluids Stan Tatkin, PsyD all rights reserved 14 MAJOR TYPES OF DEFICITS Theory of mind Memory problems Alexithymia Affect blindness Prosody Visual detail Thin boundaries Stan Tatkin, PsyD all rights reserved 15 VIDEO Primitives example Stan Tatkin, PsyD all rights reserved 5
6 Stan Tatkin, PsyD all rights reserved 16 AROUSAL REGULATION Stan Tatkin, PsyD all rights reserved 17 Window of Tolerance Stan Tatkin, PsyD all rights reserved Stan Tatkin, PsyD all rights reserved 6
7 Stan Tatkin, PsyD all rights reserved 19 Types of Arousal Regulation Autoregulation External regulation Self-regulation Interactive regulation Stan Tatkin, PsyD all rights reserved 20 Autoregulation Primitive form of selfstimulation and self-soothing No other person necessary Others can be used as selfobjects, thus making autoregulation appear interactive Interpersonal stress is reduced or eliminated Can be dissociative Avoidant individuals overuse Stan Tatkin, PsyD all rights reserved 21 External Regulation Early caregivers are external regulators of the infant s brain and body Therapists often function as external agents who soothe and stimulate patients Partners may function this way, too Process is one-way only Angry resistant individuals overuse Stan Tatkin, PsyD all rights reserved 7
8 Stan Tatkin, PsyD all rights reserved 22 Self-regulation Pro-social and pro-self (e.g., impulse control, frustration tolerance, emotion regulation, communication Adults are expected to self-regulate, except those with significant Axis I or II disorders Requires functioning ventromedial prefrontal cortex Frontal lobes exert feedback influence on subcortical structures (e.g., amygdala) Assumes good functioning of ventral vagal system and orbitofrontal cortex Stan Tatkin, PsyD all rights reserved 23 Interactive Regulation Requires self-regulation under stress conditions to maintain social engagement Often exists in a primitive form in infancy (e.g., infant-caregiver faceto-face, eye-to-eye, skin-to-skin play) In adulthood, process is highly nonverbal, intersubjective, and mutually managed Under mutual stress, sustained eye contact and use of prosody are usually required Stan Tatkin, PsyD all rights reserved 24 VIDEO Autoregulation versus external regulation Stan Tatkin, PsyD all rights reserved 8
9 Stan Tatkin, PsyD all rights reserved 25 ATTACHMENT A Psychobiological Approach to Couple Therapy 26 SECURE-INSECURE CONTINUUM Organized Attachment Secure Insecure Two-person System One-person System Fair Unfair Mutual Unjust Sensitive Insensitive Stan Tatkin, PsyD all rights reserved 27 Avoidant Distancing Auto Regulation Secure Clinging External Regulation Angry Resistant Stan Tatkin, PsyD all rights reserved 9
10 A Psychobiological Approach to Couple Therapy 28 ATTACHMENT SECURE (Anchor) Collaborative Caregivers do not require regulation Realistic sense of autonomy and relationship Not fearful of engulfment or abandonment Normal expressiveness Capable of cross-modal processing of information High verbal regarding self No difficulty shifting in either direction (solitude-interaction-solitude) Open, insightful, fresh narratives High facial, vocal, and gestural cueing Uses verbal and nonverbal social skills effectively May be guilt based Believes in true mutuality A Psychobiological Approach to Couple Therapy 29 ATTACHMENT AVOIDANT (Island) Regulation of caregivers self-esteem Aggrandized sense of autonomy Addicted to alone time Low expressiveness Deductive Low verbal regarding self Difficulty shifting from solitude to interaction Filtered, guarded, secretive Low facial, vocal, and gestural cueing Passive-aggressive Shame based My only complaint is that my partner complains. A Psychobiological Approach to Couple Therapy 30 ATTACHMENT ANGRY RESISTANT (Wave) Regulation of caregivers emotional well-being Aggrandized sense of relationship Allergic to hope High expressiveness Inductive High verbal regarding self Difficulty shifting from interaction to solitude Unfiltered, tangential, too much information High facial, vocal, and gestural cueing Relationship threatening Negativistic, punishing My complaint is that I m overwhelmed Stan Tatkin, PsyD all rights reserved 10
11 A Psychobiological Approach to Couple Therapy 31 VIDEO Island, wave and anchor couples Stan Tatkin, PsyD all rights reserved 32 THERAPEUTIC STANCE Secure functioning Stan Tatkin, PsyD all rights reserved 33 THERAPEUTIC STANCE In all therapeutic approaches, the therapist takes a stance that suggests his or her beliefs about where therapy should go. This stance must be clear, coherent, and consistent if good therapy is to occur. The PACT therapeutic stance is focused on an expectation of secure-functioning behavior in couple relationship The therapist moves partners down the tube of secure functioning Stan Tatkin, PsyD all rights reserved 11
12 Characteristics of Secure-functioning Relationships Partners operate as a two-person psychological system Based on attraction not fear Mutually amplified positives/mutually attenuated and foreshortened negatives Truly mutual: good for me and you Stan Tatkin, PsyD all rights reserved 34 Mutual protection of the primary relational system, in public and private Characteristics of Secure-functioning Relationships, cont. Partners are skilled at quickly shifting one another s state Partners reduce or eliminate threats, quick repair Partners increase reliance on interactive regulation Face to face, eye to eye Tense and relax Stan Tatkin, PsyD all rights reserved 35 Partners must become experts on each other Characteristics of Secure-functioning Relationships, cont. Partners can handle any conflict without fear of dysregulation Partners are able to resolve issues surrounding near senses Partners increase ability to play Partners are good stewards of their safety and security system Including management of thirds Stan Tatkin, PsyD all rights reserved Stan Tatkin, PsyD all rights reserved 12
13 A Psychobiological Approach to Couple Therapy 37 PACT BASIC INTERVIEWING PROCESS Stan Tatkin, PsyD all rights reserved 38 Some of the techniques covered in the PACT Training Cross-tracking, or visually scanning the partner who is not speaking Cross-questioning, or asking partners about each other ( what makes him angry? ) Cross-checking information by asking the other partner ( is that true? ) Asking the other partner s response to something said ( have you heard that before? ) Asking partners about signals ( did you see that? ) Asking partners about patterns ( is this how he generally communicates? ) Floating an idea about one partner ( did you know he was shy? ) Cross-commenting, or telling one partner about the other ( he didn t like that ) Redirecting, or getting partners to engage each other, not just talk to the therapist ( tell her that ) Confronting or interpreting down the middle Stan Tatkin, PsyD all rights reserved 39 Q & A Stan Tatkin, PsyD all rights reserved 13
14 Stan Tatkin, PsyD all rights reserved 40 Training Groups thepactinstitute.com Los Angeles, California Berkeley, California Seattle, Washington Austin Texas Boulder, Colorado Westchester, New York Washington, DC Toronto, Canada Valencia, Spain Istanbul, Tukey Melbourne, Australia A Psychobiological Approach to Couple Therapy 41 THANK YOU! Stan Tatkin, PsyD all rights reserved 14
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